Spondylitis

Spondyloarthropathy

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Spondyloarthropathy

  • Clinical Features
  • Common to every Spondyloarthropathy
  1. Inflammatory back pain
  2. Dactylitis
    1. Inflammation of entire digit
  3. Enthesitis
    1. Inflammation of tendon and ligament bony attachments
    2. Common areas of involvement
      1. Achilles tendon insertion (Calcaneus)
      2. Platar fascia insertion (Calcaneus)
      3. Patellar tendon insertion (tibial tubercle)
      4. Patella margin (superior and inferior)
      5. Metatarsal heads
      6. Spinal ligament insertion (Vertebral body)
  • Causes
  1. Ankylosing Spondylitis
  2. Reactive Arthritis (e.g. Reiter's Syndrome)
  3. Psoriatic Arthritis
  4. Inflammatory Bowel Disease with Spondyloarthropathy
  • Differential Diagnosis
  1. Rheumatoid Arthritis
  • Labs
  1. Rheumatoid Factor (RF) negative
  2. Erythrocyte Sedimentation Rate (ESR) elevated
  3. C-Reactive Protein (CRP) elevated
  4. Complete Blood Count (CBC)
  5. Anemia of Chronic Disease
  6. HLA-B27 positive
  7. Synovial Fluid exam: WBCs > 2,000/ml
  • References
  1. Liu in Noble (2001) Primary Care, p. 1280-93
  2. Kataria (2004) Am Fam Physician 69:2853-60 [PubMed]